PTSD is a psychiatric disorder that can develop after a person experiences a traumatic event. Complex PTSD, also known as CPTSD, can result if a person experiences prolonged or repeated trauma over months or years. A person with the condition may experience additional symptoms to those that define PTSD.
A hypertonic pelvic floor occurs when the muscles in the pelvic floor become too tense and are unable to relax. Many people with a tense and non-relaxing pelvic floor experience pelvic health concerns such as constipation, painful sex, urgency and pelvic pain. A hypertonic pelvic floor may also be accompanied by tension in surrounding hip and pelvic muscles such as the piriformis, obturator internus, coccygeus and hamstrings.
Several studies have shown that persistent pain after treatment for breast cancer is a common problem, ranging between 25% and 60% depending on definition, measurement, and methods of treatment. The term refers to pain in and around the area of surgery lasting beyond three months after surgery when all other causes of pain such as recurrence have been ruled out. Persistent pain after treatment has a considerable negative influence on the quality of life in breast cancer survivors.
Post-traumatic stress disorder (PTSD) is a chronic anxiety disorder caused by seeing or experiencing traumatic events. The symptoms of PTSD include re-experiencing the event through flashbacks or nightmares, avoidance of stimuli which remind the victim of the traumatic event, and increased arousal, such as anxiety, anger or hypervigilance. A formal diagnosis of PTSD requires these symptoms to persist for at least a month and to cause significant disruption in one’s personal and/or professional life. The person with PTSD has clinically significant distress and/or functional impairment.
Complex regional pain syndrome (CRPS) is a debilitating condition, characterised by pain in a limb, in association with sensory, vasomotor, sudomotor, motor and dystrophic changes. It commonly arises after an injury to that limb. Pain is typically the leading symptom of CRPS but is often associated with limb dysfunction and psychological distress. Patients frequently report neglect-like symptoms or a feeling that the limb is ‘alien’.
Chronic fatigue syndrome (CFS) is a serious disorder characterised by persistent post-exertional fatigue and substantial symptoms related to cognitive, immune and autonomous dysfunction. Disease mechanisms are complex with no single causal factor identified. Yet there are indications that infections and immunological dysfunction contribute to development and maintenance of symptoms, probably interacting with genetic and psychosocial factors.
‘Intractable hiccups’ are present if the attack lasts more than 1 month. The incidence and prevalence of persistent and intractable hiccups in the community have not been studied. Hiccups are more common in diseases affecting the gastrointestinal or central nervous systems. Up to 20% of patients with Parkinson's disease and 10% of patients with reflux symptoms complain of recurrent hiccups compared to approximately 3% of controls.
Iliotibial band syndrome is a common source of knee pain. The most common symptom is lateral knee pain caused by inflammation of the distal portion of the iliotibial band. Occasionally, however, the iliotibial band becomes inflamed at its proximal origin and causes referred hip pain. The iliotibial band is a thick band of fascia that crosses the hip joint and extends distally to insert on the patella, tibia, and biceps femoris tendon.
Chronic pelvic pain can be defined as intermittent or constant pain in the lower abdomen or pelvis of at least 6 months in duration, not occurring exclusively with menstruation or intercourse and not associated with pregnancy. It is a symptom not a diagnosis. Chronic pelvic pain presents in primary care as frequently as migraine or low-back pain and may significantly impact on a woman’s ability to function.
Trochanteric bursitis is a term used to describe chronic, intermittent pain accompanied by tenderness to palpation overlying the lateral aspect of the hip. First described by Stegemann in 1923, trochanteric bursitis has been referred to as the "Great Mimicker" because it is frequently mistaken for other conditions. Yet, the term 'trochanteric bursitis' may in fact be a misnomer given that three of the cardinal symptoms of inflammation, erythema, edema and rubor are uncommon.
Approximately 96% of all groin hernias are inguinal hernias, with the remaining 4% being femoral. Hernias are bilateral in 20% of cases. The most common abdominal wall hernia is an inguinal hernia with a male to female preponderance of 9 to 1. Femoral hernias are more common in women.
Piriformis syndrome is an elusive clinical entity. It is likely that this condition is overlooked and overdiagnosed with equal propensity. It is characterized by buttock pain with a variable component of sciatic nerve irritation and probably represents the most common cause of extraspinal sciatica. Systematic clinical assessment will generally lead to the correct diagnosis.
Phantom-limb pain is a common sequela of amputation, occurring in up to 80% of people who undergo the procedure. It must be differentiated from non-painful phantom phenomena, residual-limb pain, and non-painful residual-limb phenomena. Central changes seem to be a major determinant of phantom-limb pain; however, peripheral and psychological factors may contribute to it.
Fibromyalgia is a complex condition that is characterized by chronic widespread pain and multiple other symptoms, including fatigue, sleep disturbances, cognitive dysfunction, stiffness, and depressive episodes.
There has been a constant struggle to define the role of opioids in medical therapy, due to their potential for misuse, overuse, and addiction since pain is a completely subjective sensation, not amenable to objective measurement, and is intimately tied to emotion and the patient’s psychological well-being. Thus the medical decision to administer an opioid analgesic is an attempt to balance the potential for pain relief, and the reliability of the patient’s reporting, against the potential for harm. The decision-making process is less complicated when dealing with acute traumatic injury or surgical trauma. However, with many chronic pain conditions, the etiology or severity of the patient’s pain is less obvious. In the majority of situations, a physician does not initiate opioid therapy with the intention of continuing it for months or years, but many patients will continue to seek opioids for relief of pain which becomes chronic.
Pudendal neuralgia (PN) is defined as the existence of pain in the distribution of the pudendal nerve. Pudendal neuropathy can occur in both genders. Entrapment of the pudendal nerve can give rise to perineal pain involving the penis, scrotum, labia, perineum, or anorectal region. Three sites of entrapment of the nerve have been described. These can occur along its path between the sacrotuberous and the sacrospinous ligaments (interligamentous plane), through Alcock canal, or as the nerve passes through a tight osteofibrotic canal at the entrance to the base of the penis.
Thoracic outlet syndrome (TOS) is a poorly characterized disease entity with a wide differential diagnosis. First coined in 1956 by Peet et al, TOS can be categorized as vascular (arterial or venous) or neurogenic (NTOS). Although vascular-related TOS pathology is intuitively easier to understand and document because of more definitive imaging findings and symptoms, there remains significant controversy as to even the existence of NTOS.
Bursitis is an inflammation or degeneration of the sac-like structures that protect the soft tissues from underlying bony prominences. Bursitis may result from a local insult or be a manifestation of a systemic disease. Examples of the latter include rheumatoid arthritis, tophaceous gout, and sepsis. Adjacent tenosynovitis and calcium apatite deposition disease commonly coexist.
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